MEDICARE: KAELA CHAMPION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	23474	FL

General Provider Information

NPI Number	:	1649097361
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAELA CHAMPION

Provider Business Mailing Address
First Line	:	3724 GRAND BLVD APT 2
Second Line	:
City	:	BROOKFIELD
State	:	IL
Zip	:	60513-1641
Country	:	US
Telephone Number	:	419-309-0237
Fax Number	:

Provider Business Practice Location Address
First Line	:	3724 GRAND BLVD APT 2
Second Line	:
City	:	BROOKFIELD
State	:	IL
Zip	:	60513-1641
Country	:	US
Telephone Number	:	419-309-0237
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/24/2024
Last Update Date	:	09/24/2024

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Directions to “ KAELA CHAMPION ” Practice Location

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